1093865644 NPI number — ELIZABETH A SWANSON PA-C

Table of content: ELIZABETH A SWANSON PA-C (NPI 1093865644)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093865644 NPI number — ELIZABETH A SWANSON PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SWANSON
Provider First Name:
ELIZABETH
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093865644
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
MEDICAL ARTS ASSOCIATES, LTD.
Provider Second Line Business Mailing Address:
600 JOHN DEERE ROAD, SUITE 200
Provider Business Mailing Address City Name:
MOLINE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61265-6897
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
309-779-4200
Provider Business Mailing Address Fax Number:
309-779-4305

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
MEDICAL ARTS ASSOCIATES, LTD.
Provider Second Line Business Practice Location Address:
600 JOHN DEERE ROAD, SUITE 200
Provider Business Practice Location Address City Name:
MOLINE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61265-6897
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
309-779-4200
Provider Business Practice Location Address Fax Number:
309-779-4305
Provider Enumeration Date:
01/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AM0700X , with the licence number:  085001920 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 970030736 . This is a "RR MEDICARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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